FRAMELESS STEREOTAXIC GUIDANCE FOR SURGERY OF THE UPPER CERVICAL-SPINE

OBJECTIVE: The goal was to evaluate and describe the use of a frameles s, computed tomography-guided, stereotactic technique in complex proce dures involving the craniocervical junction. METHODS: Eleven procedure s, including transoral odontoid resection, posterior atlantoaxial fusi on with transarticular C1-C2 screw fixation, and spinal tumor resectio n, were performed in the preceding 26 months. In each case, frameless stereotaxy was used to plan the incision, to define resection margins, and to determine the appropriate orientation for instrumentation. RES ULTS: There were no intraoperative complications noted. Each patient u nderwent adequate resection of the pathological lesion and satisfactor y placement of instrumentation. The stereotactic system provided detai led anatomic visualization, which increased the confidence of the surg eon during the procedure. The system limited the need for extensive su rgical exposure, reduced fluoroscopy time, and decreased the risk of n eurovascular injury. CONCLUSION: Frameless stereotaxy provided the sur geon with intraoperative information regarding the extent of bone and soft tissue resection. It provided a multidimensional view of anatomic relationships in the operative field, which significantly increased s urgical accuracy and safety.